Veterinary Release Form

Name *

Please provide your first and last name

Pet(s) Covered by this Agreement *

Please list the name(s) of ALL pets covered by this Veterinary Release Form.

Pet Information Disclosure *

Have you completed a Pet Information Disclosure for ALL pets named and covered by this Veterinary Release Form?

Yes, I have completed the Pet Information Disclosure for all pets

No, I have not yet completed the Pet Information Disclosure and understand I must do so before service can commence.

Pet Information Disclosure

Please complete The Healthy Bone’s Pet Information Disclosure form for each pet named and covered by this Veterinary Release Form. In the unlikely event of a medical emergency, is imperative that we are able to provide as much information about your beloved pet to the attending veterinary professional.

THB Vet Release

In the event that any of my pets appear to be ill, injured, or at significant risk of experiencing a medical problem at the start of service or while in the care of The Healthy Bone, I grant permission to The Healthy Bone and all representative agents to seek veterinary service from a veterinarian or a veterinary clinic. My veterinary preferences are detailed below. Other veterinarians or emergency care clinics chosen by the pet sitter/handler are acceptable, should the situation necessitate an alternate plan of action. I understand The Healthy Bone and its representative agents will always do everything possible to utilize my preferred veterinarian.

I ask The Healthy Bone to inform the attending clinic or veterinarian of my requested total diagnosis and treatment limit as designated below (most common values are $200, $1000, or unlimited). I understand that efforts will be made to contact me regarding any treatments, illness, injury, or potential problems as soon as the condition is deemed not life-threatening and/or contact is possible. I understand that The Healthy Bone care providers work hard to prevent accidents and injuries and that such problems may occur no matter how well a pet is cared for. I agree to allow The Healthy Bone care providers to use their best judgment in handling these situations, and I understand that The Healthy Bone and its staff assume no responsibility for the actions and decisions of the veterinary staff, the health, or death of my pet(s).

I will assume full responsibility for the payment and/or reimbursement for any and all veterinary services rendered, including but not limited to diagnosis, treatment, grooming, medical supplies, and boarding. Such payments will be made within 14 days of the initial incident. I also agree to be responsible for all Special Service fees assessed by The Healthy Bone for emergency transportation, care, supervision, or hiring of emergency caregivers and will pay such fees within 14 days of each incident. I further authorize The Healthy Bone and my primary veterinarian(s) to share all of the medical records of all of my animals with veterinary clinics in an emergency in the interest of providing the best care for my ill or injured animal(s).

Every dog and cat at the site of service will be current (per my veterinarian’s recommendations) on its rabies vaccinations prior to the arrival of any caregiver. I will also make arrangements to guarantee that each animal will remain current on its rabies vaccinations throughout each service visit period.

I agree to notify The Healthy Bone of any signs of injury or possible illness before any visit as soon as the condition appears. The Healthy Bone reserves the right to cancel service at any location where a pet with a potentially infectious condition exists. The Healthy Bone strives to provide clean, safe service to each of our clients. In doing so, The Healthy Bone strongly recommends that each pet be vaccinated, dewormed, and protected from harmful insects according to veterinarian-recommended standards.

This agreement is valid from the date below and grants permission for future veterinary care without the need for additional authorization each time The Healthy Bone cares for one or more of my pets. I understand that this agreement applies to all of the pets within The Healthy Bone’s care. In electronically signing and submitting this contract, I agree that I have the sole authority to make health, medical, and financial decisions regarding the animals that will be scheduled to receive service.

Preferred Veterinarian Clinic *

Please provide the name of your preferred veterinarian clinic.

Preferred Practicioner

If you prefer that your pet(s) are seen by a specific practitioner at the above-referenced veterinarian clinic, please note that individual's name in the space provided.

Emergency Care Discretion *

While The Healthy Bone will, of course, do everything possible to ensure that your pet is seen by your chosen veterinarian, please keep in mind that in an emergency situation, your veterinarian may be unavailable/unable to attend to your pet. If immediate medical attention is required for your pet, The Healthy Bone will seek veterinarian care from the nearest veterinary facility.

I give permission for the staff of The Healthy Bone to use their best judgement in obtaining veterinary care for my pet. I understand this means my pet may be seen by a veterinary professional other than my chosen veterinarian.

Veterinarian Phone

Please provide the telephone number of your preferred veterinarian clinic

Veterinarian Address

Apt, suite, etc.

Country

City

State

Zip code

Please provide the address of your preferred veterinarian clinic

Treatment Limit

Please provide your requested total diagnosis and treatment limit. The most common values are $200, $500, $1000 or Unlimited. For unlimited, simply leave the field below empty and check the box in the field below. *It is recommended that a credit card is placed on file with your veterinarian's office.

Treatment Limit *

The aforementioned treatment limit applies to:

Each Individual Pet

All Pets

Other

ADVANCE DIRECTIVE

*PLEASE NOTE: THE HEALTHY BONE WILL ALWAYS EXHAUST ALL OPTIONS AVAILABLE IN ATTEMPT TO CONTACT YOU AND YOUR EMERGENCY CONTACT(S) BEFORE TAKING ANY SUCH ACTIONS OUTLINED BELOW. BY LAW, WE MUST HAVE THIS INFORMATION ON FILE TO ENSURE THAT WE ARE ABLE TO HONOR YOUR WISHES IN REGARDS TO YOUR BELOVED PETS WHILE THEY ARE IN OUR CARE!

Advance Directive

In the unlikely event that my pet should become ill or is injured beyond the hope of all recovery, as determined by a veterinarian, while in the care of The Healthy Bone, my wishes are as follows:

My pet is to be humanely euthanized if my veterinarian is certain that this is the most appropriate course of action for my pet.

If at all possible, I would prefer that my pet receive any and all life sustaining care (life support/pain management) necessary until I or my emergency contact can be reached.

Burial or Cremation

I wish to have my pet cremated.

I wish to bury my pet. Please keep my pet at my veterinarian's office until I am able to pick my pet up for burial. I understand that I will be responsible for arranging the burial of my pet, including the location, upon my return.

Should my pet pass away while in the care of The Healthy Bone, my wishes are as follows:

Cremation Instructions *

As identified above, I wish to have my pet cremated in the unlikely event that my pet should pass away while in the care of The Healthy Bone. I would prefer:

A solo cremation (your pet only)

Group cremation (several pets cremated together)

Cremation Remains *

Once my pet has been cremated:

I would like my pet's ashes returned to me.

I DO NOT want my pet's ashes returned to me.

Special Instructions

Please detail any instructions you'd like The Healthy Bone to follow and honor in the unlikely event your pet should pass away while in our care.

Electronic Signature

By typing my name into the box above, I am consenting to the Veterinary Release Form as set forth by The Healthy Bone.

Reset Signature

Please select today's date. *

Veterinary Release Form

"This ain't no doggy daycare!"